Cytomegalovirus adrenalitis mimicking adrenal metastasis in an immunocompetent patient

The adrenal gland is a common site of metastasis due to its rich blood supply. Adrenalectomy is typical treatment in the management of oligometastatic disease. We present an unexpected finding of cytomegalovirus (CMV)-related adrenalitis mimicking adrenal metastasis. A 54-year-old female was reviewed with a history of BRCA2-mutated, hormone receptor-positive invasive ductal cancer of the right breast diagnosed 12 years prior. Surveillance fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated a new focus of FDG avidity in the left adrenal gland, for which she underwent adrenalectomy. Histopathology revealed CMV-related adrenalitis in an otherwise immunocompetent patient without history of human immunodeficiency virus (HIV) or other immunocompromise. We describe the first case of CMV adrenalitis in a patient without acquired immunodeficiency syndrome. This case was initially presumed to be adrenal metastasis in the context of disseminated metastatic breast cancer and a PET-avid left adrenal lesion.